CROI 2025 Abstract eBook

Abstract eBook

Poster Abstracts

780

High Prevalence of Triple Infection (HIV/HBV/HDV) Among Key Populations With HIV in India Hussain Syed Iqbal 1 , Talia A. Loeb 2 , Mark Anderson 3 , Mihili Gunaratne 2 , A. K. Srikrishnan 1 , Mary Rodgers 3 , David Thomas 4 , Allison M. McFall 2 , Rifa T. Khan 1 , Ashwin Balagopal 4 , Gregory M. Lucas 4 , Shruti H. Mehta 2 , Chloe Thio 4 , Gavin Cloherty 3 , Sunil S. Solomon 4 1 YR Gaitonde Center for AIDS Research and Education, Chennai, India, 2 The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, 3 Abbott Laboratories, Abbott Park, IL, USA, 4 The Johns Hopkins University School of Medicine, Baltimore, MD, USA Background: Globally, ~ 9% of people with HIV (PWH) are co-infected with hepatitis B virus (PWHHB). Mortality, particularly liver-related mortality, is several-fold higher among PWHHB compared to PWH despite being on antiretroviral therapy (ART). Hepatitis D virus (HDV) further accelerates disease progression and hepatocellular carcinoma risk among PWHHB. Limited data exist on the burden of HDV in PWHHB, especially in key populations such as people who inject drugs (PWID) and men who have sex with men (MSM) who bear a disproportionate burden of HIV and HBV. Methods: We tested stored baseline specimens among PWID and MSM living with HIV who were recruited as part of a 16-city cluster randomized trial in India (~150 PWH per city). For inclusion, all participants needed evidence of HIV and ≥50% of the cohort was ART naïve at baseline. All specimens were screened for evidence of HBV infection (ARCHITECT HBsAg Next) and positives reflexed for anti-HDV (Research Use Only ARCHITECT HDV Total Ig). Prevalence of HIV/ HBV co-infection and triple infection (HIV/HBV/HDV) were calculated overall, by population and city. Chi squared and Kruskal Wallis tests were used to compare variables including the Signal/Cutoff (S/Co) of HBsAg between participants with triple vs. co-infection. Results: 2304 participants (PWID=1195 and MSM=1109) were enrolled between 2017-2018. Median age of PWID and MSM participants was 30 and 32 years; 13% of PWID were women. Overall, HIV/HBV co-infection prevalence was 12% and higher in PWID vs. MSM (14% vs 9%; p<0.01). In PWID with HIV/HBV co-infection, prevalence of anti-HDV was 16%; prevalence by city ranged from 0 to 36%. More frequent injection, needle sharing, and heroin injection were associated with triple infection compared to HIV/HBV co-infection; there was no association with HIV RNA or ART use. The S/Co of HBsAg was significantly higher among those with triple infection (median: 1880 vs. 107; p<0.01). In MSM with HIV/HBV infection, prevalence of triple infection was 4% (city range: 0-10%). There were no correlates associated with triple infection vs. co-infection in MSM Conclusions: The high prevalence of HDV infection among PWHHB, especially PWID, is particularly alarming given its role in accelerating liver disease. The correlation with HBsAg levels supports the dependence of HDV on HBsAg to replicate. These data underscore the importance of routine screening for anti HDV, and HBV vaccine scale-up in high burden settings to avert not only HBV infection, but also HDV infection.

HIV, with very low risk of HCC emergence after HCV cure. The incidence of HCC in subjects considered at low risk falls below the threshold of 1.0%, for which HCC surveillance is considered not cost-effective.

779

A New Point-of-Care Ultrasound Protocol for Chronic Hepatitis B and HBV/HIV Coinfection in Zambia Antonella Castagna 1 , Annie Kanunga 2 , Edford Sinkala 3 , Enock Syabbalo 4 , Helen Chitundu 4 , Carolyn Chibundi 2 , Guy K. Muula 5 , Samuel Bosomprah 2 , Giulia Morsica 1 , Costanza Bertoni 6 , Claudia Wallrauch 7 , Tom Heller 7 , Michael J. Vinikoor 2 1 IRCCS San Raffaele Scientific Institute, Milan, Italy, 2 Center for Infectious Disease Research in Zambia, Lusaka, Zambia, 3 University of Zambia, Lusaka, Zambia, 4 University Teaching Hospital, Lusaka, Zambia, 5 Centre for Infectious Disease Research in Zambia, Lusaka, Zambia, 6 San Raffaele Vita-Salute University, Milan, Italy, 7 Lighthouse Trust Clinic, Lilongwe, Malawi Background: Point-of-care ultrasound (POCUS) has emerged globally as inexpensive tool used by various healthcare professionals. We evaluated the accuracy of a novel point-of-care liver ultrasound protocol for hepatitis (PUSH) in detecting significant fibrosis, cirrhosis, and suspicious liver lesions in Zambia. Methods: We performed a real-world validation of the PUSH at University Teaching hospital in Lusaka, Zambia, from March to June 2024. Four nurses and 6 physicians with no experience in ultrasound (US) were trained over 3 days to visualize 3 liver windows (epigastric, subcostal, and right transverse), identify 4 cirrhosis-suggestive features (enlarged caudate lobe, nodular liver surface, coarse echotexture, tortuous vascularity), and liver lesions suspicious for hepatocellular carcinoma. Post-training, consecutive adult participants (PTs) with chronic hepatitis B (CHB) alone or HBV/HIV underwent PUSH. We excluded PTs with currently/recently pregnancy or known hepatitis C. Paticipants underwent reference standard tests (RST, transient elastography, fibroscan) for significant fibrosis or cirrhosis: liver stiffness, LS>7.0 kPa and LS>12.5 kPa, respectively. Reference standard for lesions was abdominal US by an experienced radiographer. Nonparametric analysis of ROC curve for PUSH was adjusted for operator type (doctor vs. nurse), sex, and HIV status. Results: 202 PTs were included in the study including 57 (28%) with HIV (see Table 1 for characteristics). According to RSTs, 30% of PTs had significant fibrosis, 12% had cirrhosis, and 4% had liver lesions. PUSH had low accuracy in detecting significant fibrosis, with sensitivity of 28.3% (17.5 – 41.4), specificity of 99.3% (96.1 – 100), and an overall ROC area under the curve (ROC-AUC) of 0.64 (0.57 – 0.70), and moderate accuracy for cirrhosis, with sensitivity of 56% (34.9 – 75.6), specificity of 97.7% (94.3 – 99.4), and ROC-AUC of 0.77(0.70 – 0.82). Higher accuracy was seen for liver lesions, with 85.7% (42.1–99.6) sensitivity, 93.5% (88.9 - 96.6) specificity, ROC-AUC of 0.90 (0.84 - 0.94). Conclusions: Newly-trained nurses and physicians in Zambia were able to use PUSH to diagnose cirrhosis with moderate accuracy and liver lesions with high accuracy in people with CHB with and without HIV coinfection. PUSH could be a useful, inexpensive tool to rapidly assess advanced liver disease and eligibility for HBV treatment in low-income settings where laboratory systems are lacking.

Poster Abstracts

781

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